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The Ultimate Stethoscope Guide | How To Use Your Stethoscope

Stethoscopes, at this point in time, are the most well-recognized symbols of medical professionals. If you’re a medical student or nursing school student, you will definitely learn all about stethoscopes and how to use them during your education and training, but it’s always recommended to come prepared after having done some personal research. Most people know of stethoscopes and the basic concept of placing one end on the patient and listening to the sounds in their body. However, only a few people (mostly just medical professionals) know of the extensive uses, context, and features of stethoscopes – all of which we’ve included in this stethoscope guide. It is extremely important to know how to use your stethoscope; Otherwise, you may make inaccurate and incorrect diagnoses. If you’re an aspiring medical professional, or just interested in the workings of stethoscopes, read on and improve your stethoscope know-how!

The Origins of The Stethoscope

The stethoscope was invented by a French Physician,  René Laennec, in 1816 at the Necker-Enfants Malades Hospital in Paris, France. His initial experiment involved, simply, a rolled up sheet of paper. By doing so, he realized he could hear the patient’s heartbeat without having to make physical contact. Using inspiration from this, he later created the first version of a stethoscope using a wooden tube and a single earpiece. Moreover, Laennec was inspired to create the stethoscope because, one day, a female patient visited him and he found it uncomfortable to place his ear directly on her chest. Thus, the stethoscope was born.

What Is A Stethoscope Used For?

A stethoscope is used for auscultation; the work of listening to the body’s sounds with a stethoscope. As a medical professional, you are trained and thus able to differentiate between ‘normal’ body sounds and any changes occurring in this respect. The following is a list of what exactly you can use your stethoscope for:

1. Observing Heart Sounds: The stethoscope is most commonly known to be used for listening to a patient’s heartbeat. Medical professionals are observing three main things when listening to a patient’s heart: the rate, type and rhythm. They are trained to distinguish between the normal sounds – e.g. lubs and dubs – and abnormal (adventitious) sounds – e.g. clicks, murmurs, gallops and rubs. A normal heart rate for children (6-15 years old) is 70-100 beats per minutes, whereas for adults (18+ years old) it is 60-100 bears per minute. The four primary areas to hear heart sounds include left and right of sternum of 2nd rib, left of sternum of 4th rib and left nipple side of the 5th rib.

2. Observing Lung Sounds: When assessing lung sounds, always begin above the clavicle and have the patient bend forward slightly for optimum sound transmission. This can be done to observe any abnormalities in the rate, rhythm, quality of breathing, inflammations, airway obstructions, etc. Moreover, listening to the right and left side subsequently will help you observe any differences the two sides may have and thus aid in making more accurate diagnoses.

3. Measuring Blood Pressure: Although this is a very common use of the stethoscope, it is often done incorrectly. An important aspect of measuring blood pressure is the placement of the blood pressure cuff. To do this correctly, the cuff should be closely-fitted to the upper arm with at least 80% of the arm’s circumference covered and the stethoscope bell should be placed directly on to the brachial artery, using firm yet light pressure.

4. Observing Bowel Sounds: This is probably the easiest use of the stethoscope. There are three types of abdominal/bowel sounds: normal, hyperactive and hypoactive.

5. Observing Bruits: Bruits refers to the abnormal sound in the blood flow. These sounds are always abnormal, and should seriously be taken note of in case they are observed in a patient’s body.

6. Hearing Aids: This is lesser-common knowledge, but stethoscopes can be used as hearing aids! By placing the earpieces in the person who is hard of hearing and speaking into the chestpiece, they will definitely be able to hear clearly due to the direct transmission of sound.

Parts of The Stethoscope

There are six main parts of a stethoscope:

1. Chestpiece: The chestpiece is the part of the stethoscope which is placed on the patient’s body. It can either be single or double-sided meaning it either has just a diaphragm or both a diaphragm and bell.

2. Diaphragm: The diaphragm is the larger side of the chestpiece, most commonly used to observe higher-frequency sounds (e.g. breath or normal heart rate sounds), in larger areas of the patient’s body.

3. Bell: The bell, as you may be able to guess, is the smaller side of the chestpiece and is most commonly used to listen to lower-frequency sounds (e.g. hearts murmurs, bruits, etc.) in smaller, more concentrated areas of the patient’s body.

4. Stem: The stem is the part that connects the chestpiece to the tubing, and is usually made of metal or steel. In the case of dual headed stethoscopes, the stem is used to switch between the diaphragm and bell.

5. Tubing: The tubing begins from the chest piece and goes up to the headset. It serves as an obstruction-free channel to hear the sounds in a patient’s body. In the case of dual lumen tubings, the inner tubing is split into two, creating two separate sound channels for optimum acoustic/sound transmission.

6. Headset: The headset is comprised of the eartips and eartubes, and is used to actually hear the sounds in the body. The eartips are the part that you physically place in your ear, whereas the eartubes are the part that connect the tubing to the eartips. For the most accurate readings and diagnoses, the eartips should sit comfortably and securely in your ears. In the case of improper placement or setting of the eartips, you may not be able to hear anything from your stethoscope!

Do I Need To Clean My Stethoscope?

Stethoscopes have been found to be one of the top causes of patient-to-patient disease transmission, so, yes you definitely need to clean your stethoscope. This is quite a simple task – just use a 70% isopropyl alcohol swab to wipe the chestpiece clean in between patient meetings. Another method to clean your stethoscope involves using mildly-soapy water. This, however, is quite inconvenient and you must ensure it has fully dried before the next use.

Which Stethoscope Should I Buy?

The answer to this question will vary greatly from person-to-person. I believe understanding the intended purpose of your stethoscope is key. In a more general respect, you should be ready to spend $70+ on your stethoscope. Of course there are cheaper stethoscopes available, but the quality will be significantly lower. To achieve higher performance and more accurate diagnoses + readings, you should invest in a slightly more expensive stethoscope. To avoid any possible risks or damage to your stethoscope, choosing a well-established and recognized brand will most definitely not hurt. The 3M Littmann Cardiology III is often looked to as the ‘standard’ in stethoscopes; and should definitely be used as a comparison-marker in your search for the best stethoscope for you. You can browse through and compare the best stethoscopes and their prices on www.amazon.com or www.amazon.ca, or read one of our many stethoscope review articles!

Frequently Asked Questions (FAQs)

1. I can hear from my stethoscope, but it’s hurting my ears. What do I do?
If your ears are hurting whilst using your stethoscope, we recommend trying different sizes of earpieces – some stethoscopes come with extra eartips, but there are many attachment/eartip kits available online. If the issue persists, try adjusting the headset tension – this is usually achieved by pinching the eartips and pushing them together or pulling them apart.

2. Can I use an adult stethoscope on a child?
Although all stethoscope function in the same way, to achieve perfect sound transmission the chestpiece must be placed directly on the patient’s body with its entire circumference being covered.

3. Do stethoscopes expire?
Although many manufacturers recommend replacing your stethoscope every two years, there is no real reason for doing so. Continue using your stethoscope until you feel there’s a decline in the sound transmission or damage to the tubing/parts.

4. Is it bad to leave your stethoscope in the car?
Any extreme temperatures can cause damage to your stethoscope – mainly the tubing. It is not recommended to leave your stethoscope in the car or anywhere it may be exposed to extremely hot/cold temperatures.

5. How do you take care of a stethoscope?
For maximum usage of your stethoscope, we recommend the following precautions: keep away from extreme temperatures, oils, and solvents, and wipe down with a 70% isopropyl alcohol swab in between patients.

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